Acute Kids Urgent Care

Registration Process

Acute Kids Urgent Care has simplified the registration process so that it should take less than two minutes to complete the one page form. The registration form may be completed at the clinic, or if you prefer, may be downloaded and completed at home.

A new registration form is required for every visit as it also includes the consent to treat your child on that date. If it is your child’s first visit to Acute Kids, we ask you to complete the full one page form. If you are a returning customer and your address has not changed, you may fill out the short form.

While your child is being treated, our staff will make a copy of your ID and insurance card, and enter all of this information into the system.

All forms are in PDF format and require Adobe Acrobat to download. If you do not have Adobe Acrobat, you may download it here for free.

Registration form

• Established Patient Form: Fill it out at home or at the clinic
• New Patient Registration Form: Fill it out at home or at the clinic

Office forms

• Preauthorization Consent for Treatment of a Minor - gives us permission to treat your child when you cannot be there
• Privacy Policy - Lawyers made us have one - it is really, really boring
• Release of Info FROM Acute Kids: Use this form if you need medical records from us
• Release of Info TO Acute Kids - Use this form if you want your physician to send records TO Acute Kids